The effect of a short-term multi-modal prehabilitation intervention on the systemic stress response in patients undergoing semi-elective surgery for gastrointestinal cancer: a randomized controlled clinical trial

Abstract

Abstract Objective To evaluate the possible effects of short-term multi-modal prehabilitation intervention on the post-operative stress response in patients undergoing semi-elective surgery for gastrointestinal cancer. Methods A prospective and randomized clinical study was conducted in 84 patients with gastrointestinal cancers who underwent semi-elective surgery in a single university clinical hospital from June 2023 to October 2023. Patients were randomized into the standard (SD) group and the short-term prehabilitation (STP)group (1:1). The SD group received routine treatment and care, while the STP group received one-week prehabilitation including physical exercise, nutritional, and psychosocial interventions. Changes in post-operative stress response, outcome and recovery of patients in each group were observed. Results The two groups of patients were similar in terms of age, gender, body mass index, ASA grade and tumor type. After surgery, concentrations of epinephrine(6h), C-reactive protein(7d), and IL-6(6h) levels were significantly lower in the STP group than in the SD group(P < 0.05). There were no significant differences in patients postoperative norepinephrine, insulin, glucose, IL-8 expression levels between the two groups at all time points. Besides, the time to first flatus(P = 0.02), first diet(P = 0.01) and ambulation(P = 0.01) were significantly reduced in the STP group than those in the SD group. Differences in drainage removal time, postoperative hospital stay, postoperative complications were not statistically significant. Conclusion Our findings demonstrated that levels of certain metabolic(epinephrine), acute phase(CRP) and cytokine(IL-6) parameters were significantly lower in the STP group than in the SD group, which reflected a lesser degree of postoperative stress response in gastrointestinal cancer patients associated with the short-term prehabilitation. Furthermore, patients gastrointestinal function and exercise tolerance could recover more quickly. Registration number This randomized, and controlled clinical trial was approved by the ethics committee of our hospital and registered in Chinese Clinical Trial Registry in January 2022 with the registration number ChiCTR2200055764.